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Meta-Analysis
. 2025 Apr;134(4):1018-1028.
doi: 10.1016/j.bja.2025.01.010. Epub 2025 Feb 6.

Home-based prehabilitation: a systematic review and meta-analysis of randomised trials

Filippo D'Amico  1 , Sara Dormio  1 , Giulia Veronesi  2 , Fabio Guarracino  3 , Katia Donadello  4 , Gilda Cinnella  5 , Riccardo Rosati  6 , Nicolò Pecorelli  7 , Gabriele Baldini  8 , Marina Pieri  9 , Giovanni Landoni  10 , Stefano Turi  1 ; PREHAB study group
Collaborators, Affiliations
Meta-Analysis

Home-based prehabilitation: a systematic review and meta-analysis of randomised trials

Filippo D'Amico et al. Br J Anaesth. 2025 Apr.

Abstract

Background: Prehabilitation aims to enhance preoperative functional capacity through exercise, nutrition, and psychological programs. Home-based prehabilitation represents an alternative to hospital prehabilitation, with the advantage of not utilising hospital resources. This review aims to evaluate adherence and clinical effectiveness of home-based prehabilitation.

Methods: We searched PubMed, Cochrane, and Embase up to October 1, 2024 for randomised controlled trials comparing home-based prehabilitation with standard care. The primary outcome was the proportion of patients with postoperative complications. Secondary outcomes included protocol adherence, and 6-min walking test. We used risk ratios (RR) and mean differences to summarise the results. The risk of bias was assessed using RoB 2 tool.

Results: We included 29 randomised trials for a total of 3508 patients. Median adherence to home-based prehabilitation programs was 82%. Home-based prehabilitation reduced the proportion of patients with postoperative complications (508/1322 [38.4%] vs 578/1335 [43.3%], risk ratio 0.84, 95% confidence interval [CI] 0.72-0.98, P=0.02, I2=44%, low certainty). After home-based prehabilitation, 6-min walking test performance was better compared with control (MD 28.2 m (95% CI 9.5-46.9; P<0.01, I2=48). Preoperative depression (MD -0.65, 95% CI -0.87 to -0.43; P<0.001, I2=0%), postoperative anxiety (MD -0.50, 95% CI -0.75 to -0.25; P<0.001, I2=0%, low certainty) and length of hospital stays (MD -0.32 days, 95% CI -0.61 to -0.03; P=0.03, I2=45%, low certainty) were lower with home-based prehabilitation.

Conclusions: Home-based prehabilitation reduced the proportion of patients with postoperative complications, but with low certainty of evidence. It also improved preoperative functional capacity, reduced hospital stays, depression and anxiety scores, with good adherence to the intervention.

Systematic review protocol: PROSPERO (CRD42024591208).

Keywords: anaesthesia; exercise; home-based; prehabilitation; preoperative rehabilitation.

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Conflict of interest statement

Declaration of interest The authors declare that they have no conflicts of interest.

Figures

Fig 1
Fig 1
PRISMA flow diagram showing literature search results. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Fig 2
Fig 2
Effect of home-based prehabilitation on the proportion of patients with postoperative complications. CI, confidence interval.
Fig 3
Fig 3
Effect of home-based prehabilitation on the 6-min walking distance measured before surgery. CI, confidence interval; sd, standard deviation.
See this image and copyright information in PMC

References

    1. Rose J., Weiser T.G., Hider P., Wilson L., Gruen R.L., Bickler S.W. Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate. Lancet Glob Health. 2015;3(Suppl 2):S13–S20. - PMC - PubMed
    1. Ljungqvist O., de Boer H.D., Balfour A., et al. Opportunities and challenges for the next phase of enhanced recovery after surgery: a review. JAMA Surg. 2021;156:775–784. - PubMed
    1. GlobalSurg Collaborative and National Institute for Health Research, Global Health Research Unit on Global Surgery Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet. 2021;397:387–397. - PMC - PubMed
    1. Yang R., Rush T., Huang C. Anesthesia for oncological surgery. Springer International Publishing; Cham: 2024. Prehabilitation; pp. 57–64.
    1. Fleurent-Grégoire C., Burgess N., McIsaac D.I., et al. Towards a common definition of surgical prehabilitation: a scoping review of randomised trials. Br J Anaesth. 2024;133:305–315. - PMC - PubMed

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